Provider Demographics
NPI:1366981607
Name:HEALTHRECLAIMED CENTER OF AUSTIN, PA
Entity type:Organization
Organization Name:HEALTHRECLAIMED CENTER OF AUSTIN, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:CHIZOMAM
Authorized Official - Last Name:OKEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-672-8797
Mailing Address - Street 1:3701 EXECUTIVE CENTER DR
Mailing Address - Street 2:211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1644
Mailing Address - Country:US
Mailing Address - Phone:512-672-8797
Mailing Address - Fax:
Practice Address - Street 1:3701 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1644
Practice Address - Country:US
Practice Address - Phone:512-672-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK93752083P0901X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH16207Medicare UPIN